Long-term Clinical Outcomes of Elderly Korean Patients with Multivessel Disease underwent Percutaneous Coronary Intervention with Drug Eluting Stents

Abdelshafi, Kareem

Background
Percutaneous coronary intervention (PCI) for multi-vessel disease has been widely used as a revascularization option for elderly patients with development of contemporary drug-eluting stents (DES). However there are limited data regarding long-term clinical outcomes following successful PCI in elderly Korean population

Methods
A total 942 patients underwent PCI ≥ 2 vessels were included. Patients were divided into two groups; 1) <70 years group (N=648) and 2) >70 years group (N=294). Individual and composite major clinical otucomes including major adverse cardiac events (MACE), the composite of total death, myocardial infarction (MI), repeat revascularization and stent thrombosis were compared between the two groups up to 5 years.

Results
At 30 days follow up, >70 years group had signficantly higher incidence of total death (HR: 5.077, 95% CI: 2.207 to 11.676; p < 0.001), cardiac death (HR: 4.182, 95% CI: 1.669 to 10.483; p = 0.002), revascularization (HR: 3.466, 95% CI: 1.724 to 6.968 ; p = 0.000) and all MACE (HR: 3.384, 95% CI : 1.721 to 6.654; p = 0.000) than <70 years group (Table 1). Using multivariate logestic regression, and after adjusting for potential risk factors, there was no significant difference between two groups in all MACE (HR: 1.430, 95% CI : 5.104 to 0.965; p = 0.582). At 1 year follow up, >70 years group had signficantly higher incidence of total death (HR: 3.268, 95% CI: 1.684 to 6.339; p = 0.000), cardiac death (HR: 2.519, 95% CI: 1.150 to 5.522; p = 0.021), however no significant difference between two groups in MACE (HR: 1.275, 95% CI : 0.888 to 1.829; p = 0.188). At 5 years follow up, >70 years group had signficantly higher incidence of total death (HR: 2.715, 95% CI: 1.446 to 5.095; p = 0.002), cardiac death (HR: 2.776 , 95% CI: 1.200 to 6.427; p = 0.017), however no significant difference between the two groups in all MACE (HR: 1.095, 95% CI : 0.818 to 1.465; p = 0.542).

Conclusions
Elderly (>70 years) Korean patients with multivessel disease treated with DESs showed higher incidence of total death and cardiac death than younger patients. However, there was no signficant difference in MI, revascularization and all MACE between the two groups up 5-year follow up .